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HomeMy WebLinkAbout030-2139-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453498 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I St. Joseph Townshi CST BM Elev: , Insp. BM Elev: BM Description: r Section/Town /Range /Map No: 0D.O lt I r MA* 1 'z C_ Auu 04.29.19. TANK INFORMATION LEVA ION DATA TYPE MANUFACTU CAPACITY STATION BS HI FS ELEV. A Septic Benchmark 3.3g / S Z Sty n�� Dosing Alt. BM i S z o LO 0 Aeration Bldg. Sewer q Holding SUHtInlet 8•D� QQ•3 St/Ht Outlet D ! 1 TANK SETBACK INFORMATION S• 3` f . p � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I $ ✓� Dt Bottom Dosing Header /Man. Q57 i tt Aeration Dist. Pipe 11. � Holding Bot. System 1 - 3 7 PUMP /SIPHON INFORMATION Final Grade ?.(00 C IF 45 1 Manufact Zr Demand St Cover 1e is Model Numb TDH Lift F Loss System Head TDH Ft Forcemain ngth Dia. Dist. to Well SOIL ABSORPTION SYSTEM RENCH Width f Length 1 No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufag�e�r: ♦ INFORMATION r CHAMBER OR I'D�fA Type Of System: / ,r UNIT J + qz ., ,� Model tuber. DISTRIBUTION SYSTEM Header /Manifold 1 46% IDistribution x Size Ix Hole Spacin g Vent to Air Intake L-r Pi Length Dia Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed(rrench Center Be d/Trench Edges Topsoil ,,. �� Yes Ej No [E Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Da. Inspection #2: Location: 1150 56th Street Houlton , W� I 5 S_�E 1/ 4 T2 9N R19W) Park Hollow Lot 1 Parcel No: 04.29.19. 1.) Alt BM Description Cr y D VK (1.- 2.) Bldg sewer length = - amount of cover = ' (� + Plan revision Required? [.. Yes No X, 0 Q �J Use other side for additional information. � SBD -6710 (R.3/97) Date Cart. No. Insepctors Signature ICI r Safety and Btuldings Division . County - -- NVisconsin 201 W. Washington Ave., P.O. Box 7162 - Cu(k Madison, Wl 53707 - 7- -152 SanitaryP 't Number (to b filled m by C:. (608).266- 3151 5 De artment of Commerce Sanitary Permit Application State Plan LD. Number y In accord with Comm 83.21, Wis. Adm. Code,•persepal information you providn ' "'` � may be used for secondary purposes Privacy 'law, s15.04(l)(m) ject Address (if different than mailing address) 1. Application lnformadon — Please Print All Informatlon t tam u>, Property Owner's Name M arce q, Lot N Bloc', Property Owner's Mailing Address jProperty Loeation 3 0 ,:lf 2 % ry th, Section City, State Zip Code Phone Number Q ad 30 r1 �� Syo�fe ?'s1a4°7 '7(/ (circ_le e) 11. Type of Building (check all that apply) T N; R�E q.J L/ Subdivision Name CSM Number �1 or 2 Family Dwelling - Number of Bedrooms .l ❑ Public/Commercial - Describe Use ' 3 9 2.�X - rleC n(C#FS ❑i o c g 4� p T State Owned - Describe Use ❑Villa a Townshi of � �� �! C1 - ts` e- Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal C1 Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner 1 V. Type of POWTS System: Check all that appl f Non - Pressurized In- Caound ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter / K1.eaehing Chamber ❑ Drip line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersalll'reatment Area Information: R- , o o5r✓ TP a Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Prop ed (so System Elevation l �o 4 00 V-7 C7 '0 933 9S. 00� _ -- V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons of Units Concrete Constructed Glass New I Exiiaing Tanks Tanta _ S:puc or xoUng Tank Aerobic Tmumcnc Unit fr W � 1 Damg Chamber x'11. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumb='s Nance (Print) Plumber's Signet MP/MPRS Number Business Phone Number — k�. Kc. f s 3 4 6,12- 49 /W Plumber's Address (Street, City, State, Zip Code) /D 70 / -/& 4 °.�j� �'11L County/ e artment Use Onl proved ❑ Disa proved____,___�� Sanitary Surcharge Fee (includes Groundwater Date Issued, is ring ent Signature No '.an psi Surcharge Fee) ❑Owner Given on for Denial 2S 0 2 1X- Conditions �ppro SYSTEM OWNER: 9 Septic tank, effluent filter and dispersal cell must all by serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not leas thaa $1/2 s 11 luchcs is site SBD -6398 (R. 01/03) I OO tA kA b : P 3�6 a nl 0 � h tj 0 � 1 T y l a Na � W � C4 N �D �A m : �. N W r p o- t P 3 �6 0 4-1 -4 CP rn v 0 N w � �V *t-- c w u o N ..Q �p i m� N W / 9s y: a RECEIVED t JAN 16 2004SOI EVALUATION REPORT 1747 Vlfisconsin Department of Com erce Page 1 of 3 Division of Safety and Building ST. CR(111A with omm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan Z IN ,F size. Plan must C ounty St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. I Pending from 030 - 1014 -50-000 Please print all information. R viewed By Date Personal information you provide may be used for se=dapr purposes (Privacy Law, s. 15.04 (1) (m)). ` ZZ W AA Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 1 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 (715) 386 - 2769 St.Joseph I River Road of New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 95.00' using 28 leaching chambers. g, Boring # Boring ✓ Pit Ground Surface elev. 98.87 ft. Depth to limiting factor >105" in. Sal Application Rate1 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-6 10yr3/3 none sil 2fcr ds as 2f,lm 0.5 0.8 ( 2 6 -19 10yr4/3 none sil 2fsbk ds cs 1fm 0.5 0.8 ( 3 19 -27 10yr5 /4 none sit 2fsbk dsh cw 1f 0.5 0.8 4 27 -38 10yr4/6 none sl 2msbk dsh cw 1f 0.5 0.9 5 38-64 10yr5/6 none s & gr 0 sg dl gw - 0.7 1.2 6 64 -105 10yr6/4 none s & gr 0 sg dl - - 0.7 1.2 � Boring # Boring ✓ Pit Ground Surface elev. 98.84 ft. Depth to limiting factor _ >1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/3 none sil 2fcr mvfr as 2f,1 m 0.5 0.8 I, 2 10 -30 10yr5/4 none sil 2fsbk mvfr cs 1fm 0.5 0.8 3 30 -36 7.5yr4/6 none gr Is 1 msbk mfr cw if 0.7 1.2 , 4 36 -78 10yr4/6 none s & gr 0 sg dl cw if 0.7 1.2 5 78 -102 10yr none s & gr 0 sg dl - - 0.7 1.2 S.J tfb,o8�, * Effluent #1 = BOD s a 30 < 220 mg/L a d TSS >30 < 1 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) \Signatu CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, O 1 54020 111132003 715 - 248 -7767 Property Owner Sam Miller Parcel ID # Pending from 030 - 1014 -50 -000 Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 97.17 ft. Depth to limiting factor >95" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 1 0 -8 10yr3/3 none SO 2fcr mvfr as 20M 0.5 0.8 1p 2 8 -23 10yr514 none sil 2fsbk mvfr cs 1fm 0.5 0.8 3 23 -31 7.5yr4/6 none gr Is 1 msbk mfr cw 1f 0.7 1.2 + 4 31 -58 10yr4/6 none gr s 0 sg dl cw if 0.7 1.2 5 58-95 10yr6/4 none s 0 sg dl - - 0.7 1.2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 " Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. ` � S oil e ✓Q /u[t�io.� 1 0"4 • 4 0 wt p ro�o..5 dot 1, P/a off' fin(' 1411.0a) sty' � wtarK: 700 of V. C. �0ipe. � 99 0' Cen1604f- 1SQ91 f ropo5c Gam"'- Town Road 8� G I S8S ' I E . I..�. M• : roe o { lob StaKe. E /c� = 9 2J' /� ; ✓e/' Qoa d R e� �17�7 Py.3a ;3 • � J c - ications if 10 BioDif fuser S Sri C= ECE End Ww Universal End Cap Chamber 11" Stan• 14" High Ca ty Ava SizeS Dimensions Bard Capacity 1v�� 1 1 s t.1� , �� hip � �ti�, rt �ryv ► ,� } "J' 4�> �,W � i � k V • t b' �� t�� / tll� � .i * � .t, ,/ wpm •�` <? +� 1 � j� �Y _� .,�E 1° .,.t; ! t1 3 4 (�`'. f ��:i Irri' �d1.• ",:' :,�,.•,,:Ifd�! �,; ;.!ri/�.%5e 0 ` a .,a. �if;P�e..e y �q r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I o f 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 57 Septic Tank Capacity I Z S O al ❑ NA Permit # LIC-72 Septic Tank Manufacturer 13 NA J �,cJ 4. S r .� DESIGN PARAMETERS Effluent Filter Manufacturer ZA 8 L ❑ NA Number of Bedrooms t ❑ NA Effluent Filter Model A _ J D O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) G7 g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) D O g al/day Pump Manufacturer ❑ NA Soil Application Rate D.'7 gal/day/ft, Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Cl NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 18 year(s) Clean effluent fitter At least once every: 2 ❑ month(s) ❑ NA fir ear(s) Inspect pump, pump controls &alarm At least once every: O month(s) ❑ ear(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the.local regulatory authority within 10 days of completion of any service event. ,UP AND OPERATION Page 7i o f 7/ new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals Fiat may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) .water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled , �jth soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant repl;� ent system: suitable replacement area has been evaluated and may be utilized for the location of a system. The replacement area should be protected from disturbance and compaction and should I not beinfriinged upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T he 640 has mat beeii e tv- �f alua ' j re 5 b e ate . � MaMa LlC �'ot2 A/�1^J CaNS^77Z� C tank ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENTJANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name POWTS MAINTAINER NL�-C l� Name Phone 6 f2. ?6 5` I (2 Phone -a'l s /9Z- SEPTAGE SERVICING OPERATO (PUMPER) LOCAL REGULATORY AUTHORITY Name N E ame dTy Phone ( ���� Phone '7 /S"— 3�Co— /O (D This document w drahed in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83,54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S to /37 /L L 4X_T Mailing Address Property Address (Verification required from Planning Department for new construction) City/State - /& o(s o *r Gv Parcel Identification Number ��� — t° t LEGAL DESCRIPTION Property Location 15 U '/4, M E '/,, Sec. � , T11 N -RITA, Town of 5 Subdivision P-- k H ©LL O W . Lot # Certified Survey Map Volume . Page # & Warranty Deed # - 7/ Volume Z Page # ©,3 Spec house 0 yes ❑ no Lot lines identifiable Kyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year ex iration date. :S" ) � 1 2,& 1 0 3 GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ,P A AP ICANT DATE •••••* Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. • ► « «.. '• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I 'J 2 2 19 P 0 0 3 - 71 8249 HATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM I - 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04/21/2003 03:00PM Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under t he Wisconsin Uniform Transfers to Minors Act WARRANTY DEED EXEMPT I Grantor, and Sam E. Miller REC FEE: 11.00 TRANS FEE: 1477.50 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in SL Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address Sam E. Miller P. O. Box 151 Hudson, Wl 54016 L The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030 - 1014 -50 -000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 17th day of April 2003 Wv/ 4L G_ M, ames E. Ebbe . Thomas A. Ebbe custodian for Theodore A. Ebbe ii ACKNOWLEDGMENT AUTHENTICA -4 , x pUe /C fir'!! STATE OF WISCONSIN ) Signature(s) e� �;. ) ss. St. C roix County. ) OE i Personally came before me this 17th day of r' %; P i authenticated this day of April, 2003 the above named � X J off= James E. Ebbe and Thomas A. Ebbe TITLE: MEMBER STATE BAR OF WISCONSIN to me k own to be the persons o executed the foregoing (If not, ins t t nd acl o get authorized by $ 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law U 502 Second Street, Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is ermanent. (If not, state expiration date: necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN WARRANTY DEED FORM N•. 1 • ISfa INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800.635.2021 'll �J Zj I9; Ni-Jw win.h ,ll[ SONVI 0311V1dNf1 ����� �F 1 .91'6lC k o Y Y r• a a •'. i, t? ■ 'Cy, a '[� . +;' I 1 7 d6 ° • .J� F '' B 6 ��) G Y� � .'� �Q. '`'�� to � 1 '•i�.... i m I 1� .......... .... ......... 1 M ai KM / G / / :8 '. / :'„t8 a `-••. \ = 'S� \•�. I _ _ _ _ _I I `l zi • 1 AJ \ sow 3.,C.W=k , � ........ .................. . ... I I ,ra• .. �� as a x '•k �" ��a c, i. Z s o - s . Y w i g Elp .: . ....:t!.... . • I a, ti < I 's i . ..............................: •I ....... ............................... ...........- I ' Q ........ ......... I M�pp9°M ,90'911 N 1 _tiy L — � { M. 1. nl I f M.fl I/I W ^^Y I -- .w7ot9 Ln.00Am -- I r,`• Ix' x u!i is 3, 'r. Scin m;J I 60o pd 'c . 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